DESCRIPTION: Insertion of a peripheral intravenous catheter (IV) is one of the most frequently performed procedures by nurses, affecting approximately 25 million persons in the United States annually. Previous research has established that IV insertion is painful and that patient satisfaction with nursing care is based in part on how skillfully and painlessly IV's are inserted. Nonpharmacologic strategies such as cognitive-behavioral interventions are safe, inexpensive, easy to implement, and can be performed independently by the nurse, and may reduce the pain of IV insertion, thus contributing to improved patient outcomes. However, little research has examined their effectiveness for pain of IV insertion. The purpose of this experimental study is to compare the effect of three cognitive-behavioral interventions (taped guided imagery, listening to self-selected music, and viewing a kaleidoscope) and usual care on IV insertion pain intensity and distress in patients having IV's inserted prior to endoscopic or surgical procedures. The effect on pain of having subjects choose the cognitive-behavioral intervention (subject choice), versus the researcher randomly assigning the intervention will also be examined. Three hundred and twenty adult subjects will be recruited from the same-day surgery or endoscopy laboratory patient population in tow health-care institutions in Northeast Ohio. Subjects will be initially randomly assigned to two groups. One group (n = 160) will receive a randomly assigned cognitive-behavioral intervention or usual care. The other group (n = 160) will choose one of the three interventions or usual care. Following insertion of their IV, subjects will rate the intensity and distress of the procedure on two 11-point numeric rating scales, and the nurse will rate the difficulty of the insertion on an 11-point rating scale. Differences among treatment groups will be analyzed by multivariate analysis of variance (MANOVA). The role of insertion difficulty and duration of insertion attempt will be analyzed with correlational techniques. Identifying nonpharmacologic methods to reduce the pain of IV insertion will assist nurses in planning appropriate pain management strategies for this widespread practice. Findings from the study will contribute to the body of knowledge of cognitive strategies for pain management in acute care.